Form QID Pesticide Safety Practices Survey

PESTICIDE SAFETY PRACTICES SURVEY – November 2014

			OMB No. xxxx-xxxx Approval Expires: x/xx/xxxx Project Code: xxx QID: xxxxxx SMetaKey: xxxx
DRAFT
				NATIONAL AGRICULTURAL STATISTICS SERVICE

Please make corrections to name, address and ZIP Code, if necessary. We are collecting information on pesticide safety practices and the factors that contribute to them. We need your help to make this information as accurate as possible. Under Title 7 of the U.S. Code and CIPSEA (Public Law 107-347), facts about your operation are kept confidential and used only for statistical purposes in combination with similar reports from other producers. Response is voluntary. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is xxxx-xxxx. The time required to complete this information collection is estimated to average 50 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

SECTION A: THE APPLICATOR

Year

0100

These first few questions are about you.

1. In what year were you born? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

[Select gender, if unsure ask:]

2. What is your gender?

0101

1 Male

[Go to Q4]

2 Female

3 DK

4 REF

3. [Does respondent have a beard that extends along the jawline from ear to ear?]

0102

1 Yes

3 No

2 DK

4 N/A

4. Do you consider yourself to be of Hispanic or Latino decent?

0103

1 Yes

3 No

2 DK

4 REF

5. Please tell me which one or more of the following categories best describes your race.

(Check all that apply)

0104 American Indian or Alaska Native

0105 Asian

0106 Black or African American

0107 Native Hawaiian or other Pacific Islander

0108 White or Caucasian

0109 DK

0110 REF

6. Do you have a high school or equivalent GED degree?

0111

1 Yes

3 No

2 DK

4 REF

7. Do you have a college degree?

0112

1 Yes

3 No

2 DK

4 REF

8. Do you have a degree or certificate from a trade school, or vocational or technical program?

0113

1 Yes

3 No

2 DK

4 REF

9. Are you currently married?

0114

1 Yes

3 No

2 DK

4 REF

10. Do you have any children under the age of 19?

0115

1 Yes

3 No

2 DK

4 REF

11. [SHOWCARD A] I will read 20 phrases that describe people’s behaviors.

Please indicate how accurately each phrase describes you, using one of the responses from the card.

Describe yourself as you generally are now, not as you wish to be in the future.

Describe yourself in relation to other people you know, of the same gender, and roughly your age.

	1	2	3	4	5
	Very Inaccurate	Moderately Inaccurate	Neither Inaccurate nor Accurate	Moderately Accurate	Very Accurate	DK	REF
a. I am always prepared								0116
b.  I often forget to put things back in their proper place								0117
c.  I pay attention to detail								0118
d.  I make a mess of things								0119
e.  I get chores done right away								0120
f.  I leave my belongings around								0121
g.  I like to have order								0122
h.  I avoid my responsibilities								0123
i.  I follow a schedule								0124
j.  I am precise in my work								0125
k.  I enjoy being reckless								0126
l.  I would never go hang gliding or bungee jumping								0127
m.  I take risks								0128
n.  I would never make a high risk investment								0129
o.  I seek danger								0130
p.  I stick to the rules								0131
q.  I know how to get around the rules								0132
r.  I avoid dangerous situations								0133
s.  I am willing to try anything once								0134
t.  I seek adventure								0135

Years

0136

Pesticides include any fungicide, herbicide, insecticide, rodenticide, growth regulator or fumigant.

12. For about how many years have you personally applied chemical pesticides for crop production in

your business? . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0538 DK

0539 REF

13. Do you currently hold any of the following types of pesticide applicator licenses in the state of Pennsylvania?

(Check all that apply)

0137 Private

0138 Commercial or Public

0139 Business

0140 NONE – I don’t have a pesticide applicator license in the state of Pennsylvania

0141 DK

0142 REF

14. Does a licensed pesticide applicator supervise you when you personally apply pesticides?

0143

1 Yes

3 No

2 DK

4 REF

15. Have you ever experienced any ill effects of pesticide exposure, including even a temporary change in your normal

functioning?

0144

1 Yes

3 No

2 DK

4 REF

16. Do you continue to have any ill effects from an exposure to pesticide in the past?

0145

1 Yes

3 No

2 DK

4 REF

5 N/A

17. [Show pesticide label]

When we first contacted you, you indicated that you recently applied [RSCREEN1], [RSCREEN2], and [RSCREEN3]

using a method other than a helicopter, airplane, or enclosed cab vehicle, to produce crops in your business.

Please look at this product label for [RSCREEN4].

Is this the same product of [RSCREEN 4] as the one you recently used?

0146

[Add to Reference (R17) & Go to Q18]

1 Yes

3 No

2 DK

Years

0147

4 REF

18. For approximately how many years have you personally applied the same product of

[RSCREEN 4]?

0540 DK

0541 REF

SECTION B: THE APPLICATION

The next few questions are about how you last applied [RSCREEN4] using a method other than helicopters, airplanes, or enclosed cab vehicles.

19. Which one of the following locations most closely resembles the location where you last applied [RSCREEN4]?

(Check one)

0148

1 On your farm

2 In your nursery

[Add to Reference (R19) & Continue]

3 In your orchard

4 In your greenhouse

5 Someplace else – Specify: 0148___________________________________

6 DK

7 REF

20. Did you last apply [RSCREEN4] as a pre-emergent to the soil or seeds, or, as a post-emergent to crops?

0149?

1 Pre-emergent

2 Post-emergent

3 Other

4 DK

5 REF

21. To which crops, or type of crops, did you last apply [RSCREEN4] [R19]?

[If respondent specifies more than 3, ask:] Which three crops, or type of crops, required the longest application of

time?

Specify crop: 0150?________________________________________________________________

Specify crop: 0151?________________________________________________________________

Specify crop: 0152?________________________________________________________________

22. [SHOWCARD B] Please look at this card.

It lists some ways that chemical pesticides may be applied using methods other than airplanes, helicopters, and

enclosed cab vehicles.

Which one of the following best describes the method you used the last time you applied [RSCREEN4] [R19]?

(Check one)

0153?

1 Hand-held sprayer equipment, such as a backpack with a hand-held mist blower sprayer, wand, or gun

sprayer, and a hose-end spray gun attached to a tank – [Go to Q23]

2 Vehicle- or horse-mounted/pulled equipment – [Go to Q25]

3 A small-scale granule applicator, such as a belly grinder, drop or rotary

spreader, or backpack granule applicator

4 Dip treatment

[Go to Q26]

5 Chemigation

6 No special equipment – such as hands, cups, spoons, shaker cans, or

trigger sprayers

7 Other – Specify: 0154?___________________________________

8 DK

9 REF

23. What type of hand-held sprayer equipment was it? (Check one)

0155?

1 Manual backpack with a wand or gun sprayer

2 Motorized backpack with a wand or gun sprayer

3 Motorized backpack mist blower sprayer

4 Hose-end spray gun attached to tank

5 Other – Specify: 0156___________________________________

6 DK

7 REF

8 N/A

PSI

0157

24. At approximately what pressure was the spray applied? Please use PSI, for pounds per square

inch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0542 DK

0543 REF

0544 N/A

[Go to Q26]

25. What type of equipment was it? (Check one)

0158

1 Airblast/Multi-head/Tunnel Recycler/ or Electrostatic Tower

2 Ground Boom

3 Broadcast spreader

4 Wipers

5 Fogger tank

6 Fumigant injector

7 Other – Specify: 0159___________________________________

8 DK

9 REF

10 N/A

26. Was any part of that most recent application made indoors, such as in a greenhouse, shedhouse or shadehouse?

0160

1 Yes

3 No

2 DK

4 REF

5 N/A

27. At any time during that most recent application, did you apply [RSCREEN4] above your head?

0161

1 Yes

3 No

2 DK

4 REF

5 N/A

CHECKPOINT 1:

SEE REFERENCE TABLE, COLUMN 1. SELECT THE APPLICABLE REQUIREMENTS (AS NECESSARY).

SECTION C1: HEADWEAR

The next few questions are about what you wore the last time you applied [RSCREEN4] [R19].

28. During your most recent application of [RSCREEN4] [R19], did you wear something on top of your head such as a

scarf, baseball cap, hat, hood, or helmet?

0162

1 Yes – [Go to Q30]

[Add to Reference (R28_30_33) & Go to Q29]

3 No

2 DK

4 REF

29. Have you ever worn anything on top of your head when you have applied [RSCREEN4] [R19] in the past?

0163

1 Yes

[Go to Checkpoint 2]

3 No

2 DK

4 REF

5 N/A

30. [SHOWCARD C1] Which one of these images most closely resembles what you wore on top of your head when

you last applied [RSCREEN4] [R19]?

[Read labels to respondent]

0164

1 Bandanna, scarf, or t-shirt – [Go to Checkpoint 2]

2 Baseball cap or short-brimmed hat – [Go to Q31]

[Add to Reference (R28_30_33) & Go to specified question/item]

3 Wide-brimmed hat (wide brim all the way around) – [Go to Q31]

4 Hood – [Go to Q31]

5 Hooded respirator – [Go to Q31]

6 Helmet or helmet respirator – [Go to Q31]

8

[Go to Checkpoint 2]

DK

9 REF

10 N/A

31. What was the [R28_30_33] made of?

(Check all that apply)

0165 Breathable material, such as cotton or nylon

0166 Leather

0167 Water resistant material

0168 Waterproof material

0518 NONE OF THE ABOVE

0170 DK

0171 REF

0172 N/A

32. Was the material chemical resistant?

0525

1 Yes

3 No

2 DK

4 REF

5 N/A

33. Did you wear a cover over your [R28_30_33]?

0173

1 Yes [Add to Reference (R28_30_33) & Go to Q34]

[Go to Q36]

3 No

2 DK

4 REF

5 N/A

34. What was that cover made of?

(Check all that apply)

0526 Breathable material, such as cotton or nylon

0527 Water resistant material

0528 Waterproof material

0519 NONE OF THE ABOVE

0177 DK

0178 REF

0179 N/A

35. Was the material chemical resistant?

0529

1 Yes

3 No

2 DK

4 REF

5 N/A

36. Have you always worn the same [R28_30_33], or type of [R28_30_33], whenever you have applied [RSCREEN4] [R19]

in the past?

0180

1 Yes

3 No

2 DK

4 REF

5 N/A

37. Did you wear the [R28_30_33], in part, to help protect your head from being exposed to [RSCREEN4]?

0181

1 Yes

3 No

2 DK

4 REF

5 N/A

38. Did anyone advise you to wear the [R28_30_33] for head protection while applying [RSCREEN4]?

0182

1 Yes

3 No

2 DK

4 REF

5 N/A

CHECKPOINT 2:

WAS THE CORRECT HEADWEAR WORN?

NOTE: IF R17 = NO, DK, OR REF, THEN [CORRECT] = DK

0183

1 Yes

3 No

2 DK

4 N/A

COMPLETE REFERENCE TABLE COLUMN 3 [CORRECT]

SECTION C2: EYEWEAR

39. During your most recent application of [RSCREEN4] [R19], did you wear something over your eyes such as glasses, goggles, a face shield, or a full-face respirator?

0184

1 Yes – [Go to Q41]

[Add to Reference (R39_41) & Go to Q40]

3 No

2 DK

4 REF

40. Have you ever worn anything over your eyes, other than prescription glasses or ordinary sun glasses, whenever you

have applied [RSCREEN4] [R19] in the past?

0185

1 Yes

[Go to Checkpoint 3]

3 No

2 DK

4 REF

5 N/A

41. [SHOWCARD C2] Which of one of these images most closely resembles what you wore over your eyes when you

last applied [RSCREEN4] [R19]?

[Read labels to respondent]

0186

1 Glasses (includes prescription and non-prescription) – [Go to Q42]

[Add to Reference (R39_41) & Go to specified question/item]

2 Goggles – [Go to Q44]

3 Face shield – [Go to Q46]

4 Full-face respirator – [Go to Q46]

5 Helmet respirator with face shield – [Go to Q46]

[Go to Checkpoint 3]

6 DK

7 REF

8 N/A

42. [SHOWCARD C2. Point to images of side protection] Did those glasses have side shields near your temples?

0187

1 Yes

3 No

2 DK

4 REF

5 N/A

43. [SHOWCARD C2. Point to images of brow protection] Did those glasses have extra shielding on top of the

lenses near your forehead?

0188

1 Yes

[Go to Q46]

3 No

2 DK

4 REF

5 N/A

44. [SHOWCARD C2. Point to the image of the goggles with shields] Did those goggles have vents or holes for

airflow, that were not shielded?

0189

1 Yes

3 No

2 DK

4 REF

5 N/A

45. Did they have a foam inner lining where they rest against your face?

0190

1 Yes

3 No

2 DK

4 REF

5 N/A

46. Have you always worn the same [R39_41], or type of [R39_41], whenever have you applied [RSCREEN4] [R19] in the

past?

0191

1 Yes

3 No

2 DK

4 REF

5 N/A

47. Did you wear the [R39_41], in part, to help protect your eyes from being exposed to [RSCREEN4]?

0192

1 Yes

3 No

2 DK

4 REF

5 N/A

48. Did anyone advise you to wear the [R39_41] for eye protection while applying [RSCREEN4]?

0193

1 Yes

3 No

2 DK

4 REF

5 N/A

CHECKPOINT 3:

WAS THE CORRECT EYEWEAR WORN?

NOTE: IF R17 = NO, DK, OR REF, THEN [CORRECT] = DK

0194

1 Yes

3 No

2 DK

4 N/A

COMPLETE REFERENCE TABLE COLUMN 3 [CORRECT]

SECTION C3: CLOTHING

49. [SHOWCARD C3] Please select the images that most closely resemble the outer layer of clothing you

wore when you last applied [RSCREEN4] [R19].

[Read labels to respondent]

0195

1 Short sleeved shirt

2 Long sleeved shirt

[Go to Q50]

3 Shorts or short pants

[Add to Reference (R49_56_57) & Go to the specified question/item]

4 Long pants

5 Jacket

6 Coveralls

7 Set of jacket and pants

[Go to Checkpoint 4]

8 NONE

9 DK

10 REF

50. What were/was the [R49_56_57] made from?

(Check all that apply)

0196 Breathable materials, such as cotton or nylon

0197 Leather

0198 Water- or liquid-proof materials

0520 NONE OF THE ABOVE

0200 DK

0201 REF

0202 N/A

51. Was/were the material(s) chemical resistant?

0530

1 Yes

3 No

2 DK

4 REF

5 N/A

52. After you finished applying [RSCREEN4], did you change out of your [R49_56_57] before entering your home?

0203

1 Yes

3 No

2 DK

4 REF

5 N/A

53. Have you reworn the same [R49_56_57] after wearing them to apply [RSCREEN4] [R19]?

0204

1 Yes

[Go to Q56]

3 No

2 DK

4 REF

5 N/A

54. Did you wash the [R49_56_57] before wearing them again?

0205

1 Yes

[Go to Q56]

3 No

2 DK

4 REF

5 N/A

55. Did you wash the [R49_56_57] with any personal or family laundry?

0206

1 Yes

3 No

2 DK

4 REF

5 N/A

56. Excluding underwear, did you wear other clothing underneath the [R49_56_57]?

0207

1 Yes – [Go to Q57]

[Add to Reference (R49_56_57) & Go to Q60]

3 No

2 DK

4 REF

5 N/A

57. [SHOWCARD C3] Please select the images that most closely resemble the clothing that you wore

underneath your [R49_56_57] when you last applied [RSCREEN4] [R19].

(Check all that apply)

0208 Short-sleeved shirt

0209 Long sleeved shirt

0210 Shorts or short pants

0211 Long pants

[Add to Reference (R49_56_57) & Go to Q58]

0212 Jacket

0213 Coveralls

0214 Set of jacket and pants

[Go to Q58]

0215 DK

0216 REF

0217 N/A

58. What was the clothing you wore underneath made from?

(Check all that apply)

0196 Breathable materials, such as cotton or nylon

0197 Leather

0198 Water- or liquid-proof materials

0520 NONE OF THE ABOVE

0200 DK

0201 REF

0202 N/A

59. Was/were the material(s) chemical resistant?

0531

1 Yes

3 No

2 DK

4 REF

5 N/A

60. Have you always worn the same [R49_56_57], or type of [R49_56_57], whenever you have applied [RSCREEN4] [R19]

in the past?

0218

1 Yes

3 No

2 DK

4 REF

5 N/A

61. Did you wear the [R49_56_57], in part, to help protect you from being exposed to [RSCREEN4]?

0219

1 Yes

3 No

2 DK

4 REF

5 N/A

62. Did anyone advise you to wear the [R49_56_57] for protection while applying [RSCREEN4]?

0220

1 Yes

3 No

2 DK

4 REF

5 N/A

CHECKPOINT 4:

WAS THE CORRECT CLOTHING WORN?

NOTE: IF R17 = NO, DK, OR REF, THEN [CORRECT] = DK

0221

1 Yes

3 No

2 DK

4 N/A

COMPLETE REFERENCE TABLE COLUMN 3 [CORRECT]

SECTION C4: FOOTWEAR

63. [SHOWCARD C4] Which one of these images most closely resembles what you wore on your feet when you last

applied [RSCREEN4] [R19]?

[Read labels to respondent]

0222

1 Sandals, or other open-toe or open-heel shoes – [Go to Q64]

2 Closed-toe and closed-heel shoes or overshoes – [Go to Q65]

[Add to Reference (R63_70) & Go to the specified question]

3 Boots or overboots – [Go to Q65]

[Go to Q64]

4 NONE

5 DK

6 REF

64. Have you ever worn any closed-toe and closed heel-shoes, or boots whenever you have applied [RSCREEN4] [R19] in the past?

0223

1 Yes

[Go to Checkpoint 5]

3 No

2 DK

4 REF

5 N/A

65. Did you wear socks?

0224

1 Yes

3 No

2 DK

4 REF

5 N/A

66. Were the [R63_70] made of …?

(Check all that apply)

0225 Breathable material, such as cotton or nylon

0226 Leather

0227 Waterproof material

0521 NONE OF THE ABOVE

0229 DK

0230 REF

0231 N/A

67. Was/were the material(s) chemical resistant?

0532

1 Yes

3 No

2 DK

4 REF

5 N/A

68. After you finished applying [RSCREEN4], did you take off your [R63_70] before entering your home?

0232

1 Yes – [Go to Q70]

[Go to Q69]

3 No

2 DK

4 REF

5 N/A

69. Did you wash the [R63_70] before wearing them in your home?

0233

1 Yes

3 No

2 DK

4 REF

5 N/A

70. [SHOWCARD C4. Point to images of shoe/boot covers] Did you wear covers over your [R63_70]?

[Read labels to respondent]

0234

[Add to Reference (R63_70) & Go to Q71]

1 Yes

3 No

Go to Q73

2 DK

4 REF

5 N/A

71. What were those covers made of?

(Check all that apply)

0225 Breathable material, such as cotton or nylon

0235 Waterproof material

0522 NONE OF THE ABOVE

0237 DK

0238 REF

0239 N/A

72. Was the material chemical resistant?

0533

1 Yes

3 No

2 DK

4 REF

5 N/A

73. Have you always worn the same [R63_70], or type of [R63_70], while applying [RSCREEN4] [R19]?

0468

1 Yes

3 No

2 DK

4 REF

5 N/A

74. Did you wear the [R63_70], in part, to help protect your feet from being exposed to [RSCREEN4]?

0469

1 Yes

3 No

2 DK

4 REF

5 N/A

75. Did anyone advise you to wear the [R63_70] for foot protection while applying [RSCREEN4]?

0470

1 Yes

3 No

2 DK

4 REF

5 N/A

CHECKPOINT 5:

WAS THE CORRECT FOOTWEAR WORN?

NOTE: IF R17 = NO, DK, OR REF, THEN [CORRECT] = DK

0471

1 Yes

3 No

2 DK

4 N/A

COMPLETE REFERENCE TABLE COLUMN 3 [CORRECT]

SECTION C5: GLOVES

76. During your most recent application of [RSCREEN4] [R19], did you wear gloves?

0240

1 Yes – [Go to Q78]

[Go to Q77]

[Add to Reference (R76) & Go to specified question]

3 No

2 DK

4 REF

77. Have you ever worn gloves whenever you have applied [RSCREEN4] [R19] in the past?

0241

1 Yes

[Go to Checkpoint 7a]

3 No

2 DK

4 REF

5 N/A

78. Did you wear more than one glove at a time on either hand when you last applied [RSCREEN4] [R19]?

0242

[Add to Reference (R78) & Go to Q79]

1 Yes

3 No

2 DK

4 REF

Color

0243

5 N/A

79. [If R78=YES, refer to the “outer gloves,” otherwise refer to the “gloves”] What color were your (outer) gloves? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0472 DK

0473 REF

0474 N/A

80. [If R78=YES, refer to the “outer gloves,” otherwise refer to the “gloves”] What were the (outer) gloves made of?

(Check all that apply)

0244 Breathable material, such as cotton or nylon

0245 Leather

0246 Rubber material

0247 Plastic material

0248 Waterproof material

0523 NONE OF THE ABOVE

0249 DK

0250 REF

0251 N/A

81. [If R78=YES, refer to the “outer gloves,” otherwise refer to the “gloves”] Were the (outer) gloves made of a chemical resistant material?

0252

1 Yes – [Go to Q82]

[Go to Q84]

[Add to Reference (R81) & Go to specified question]

3 No

2 DK

4 REF

5 N/A

82. [SHOWCARD C5.1] Please look at this card. It lists some chemical resistant materials for gloves.

[If R78=YES, refer to the “outer gloves,” otherwise refer to the “gloves”] Do you know which type of chemical resistant material the (outer) gloves were made of, or not?

– [Go to Q83]

0253

1 Yes – KNOW THE TYPE OF MATERIAL

[Go to Q84]

3 No – DO NOT KNOW THE TYPE OF MATERIAL

4 REF

5 N/A

83. [SHOWCARD C5.1]

[If R78=YES, refer to the “outer gloves,” otherwise refer to the “gloves”] What kind of chemical resistant material

were the (outer) gloves made of? (Check one)

0254

1 Nitrile rubber

2 Neoprene rubber

3 Butyl rubber

4 Polyvinyl chloride (PVC) rubber

5 Natural latex rubber

6 Viton rubber

7 Polyethylene

8 Barrier laminate

9 Other – Specify: 0255___________________________________

10 DK

11 REF

12 N/A

Gloves come in different lengths.

84. [SHOWCARD C5].

[If R78=YES, refer to the “outer gloves,” otherwise refer to the “gloves”] Did your (outer) gloves stop at about the

wrist or extend past the wrist at least two inches?

0256

1 Stop at about the wrist

2 Extend at least 2 inches past the wrist

3 DK

4 REF

5 N/A

85. [Provide glove swatches]. These materials range in thickness from smallest to largest. Please feel each one.

[If R78=YES, refer to the “outer gloves,” otherwise refer to the “gloves”] Which one most closely resembles the

thickness of the (outer) gloves? (Check one)

0257

1 4

2 8

3 12

4 15

5 22

6 DK

7 REF

8 N/A

86. [If R78=YES, refer to the “outer gloves,” otherwise refer to the “gloves”] Did your (outer) gloves have a non-

removable inner lining made of an absorbent material, such as cotton, flock, or jersey?

0258

1 Yes

3 No

2 DK

4 REF

5 N/A

87. [If R78=YES, refer to the “outer gloves,” otherwise refer to the “gloves”] Have you ever reused the same pair of (outer) gloves to apply [RSCREEN4] on a different day?

0259

1 Yes

[Add to Reference (R87) & Go to Checkpoint 6]

3 No

2 DK

4 REF

5 N/A

CHECKPOINT 6:

WHAT IS R78?

YES

NO/DK/REF

GO TO Q88

GO TO Q97

Color

0260

88. What color were the inner gloves? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0475 DK

0476 REF

0477 N/A

89. What were the inner gloves made of?

(Check all that apply)

0261 Breathable material, such as cotton or nylon

0262 Leather

0263 Rubber material

0264 Plastic material

0265 Waterproof material

0524 NONE OF THE ABOVE

0267 DK

0268 REF

0269 N/A

90. Were the inner gloves made of a chemical resistant material?

0534

1 Yes – [Go to Q91]

[Go to Q93]

[Add to Reference (R90) & Go to specified question]

3 No

2 DK

4 REF

5 N/A

91. [SHOWCARD C5.1] Please look at this card. It lists some chemical resistant materials for gloves.

Do you know which type of chemical resistant material the inner gloves were made of, or not?

– [Go to Q92]

0535

1 Yes – KNOW THE TYPE OF MATERIAL –

[Go to Q93]

3 No – DO NOT KNOW THE TYPE OF MATERIAL

4 REF

5 N/A

92. [SHOWCARD C5.1]

What kind of chemical resistant material were the inner gloves made of? (Check one)

0536

1 Nitrile rubber

2 Neoprene rubber

3 Butyl rubber

4 Polyvinyl chloride (PVC) rubber

5 Natural latex rubber

6 Viton rubber

7 Polyethylene

8 Barrier laminate

9 Other – Specify: 0537___________________________________

10 DK

11 REF

12 N/A

93. [SHOWCARD C5] Did your inner gloves stop about at the wrist or extend past the wrist at least two inches?

0270

1 Stop at about the wrist

2 Extend at least 2 inches past the wrist

3 DK

4 REF

5 N/A

94. [Provide glove swatches] Please feel each material. They range in thickness from smallest to largest.

Which one most closely resembles the thickness of your inner gloves? (Check one)

0271

1 4

2 8

3 12

4 15

5 22

6 DK

7 REF

8 N/A

95. Did the inner gloves have a non-removable inner lining made of an absorbent material, such as cotton, flock, or jersey?

0272

1 Yes

3 No

2 DK

4 REF

5 N/A

96. Have you ever reused the same pair of the inner gloves to apply [RSCREEN4] on a different day?

0273

1 Yes

3 No

2 DK

4 REF

5 N/A

97. [If R78=YES, refer to “2 pair of gloves,” otherwise refer to the “gloves”] Have you always worn the same (2 pairs of)

gloves, or type of gloves, whenever you have applied [RSCREEN4] [R19] in the past?

0274

1 Yes

3 No

2 DK

4 REF

5 N/A

98. Did you wear the gloves, in part, to help protect your hands from being exposed to [RSCREEN4]?

0275

1 Yes

3 No

2 DK

4 REF

5 N/A

99. Did anyone advise you to wear the gloves to protect your hands while applying [RSCREEN4]?

0276

1 Yes

3 No

2 DK

4 REF

5 N/A

CHECKPOINT 7a:

WERE EITHER OF THE OUTER OR INNER GLOVESCORRECT?

NOTE: IF R17 = NO, DK, OR REF, THEN [CORRECT] = DK

0277

1 Yes

3 No

2 DK

4 N/A

COMPLETE REFERENCE TABLE COLUMN 3 [CORRECT]

CHECKPOINT 7b:

WERE EITHER OF THE OUTER OR INNER GLOVES CORRECT?

NO/DK/NA

YES

GO TO Q105

WHAT IS R78?

YES/DK/REF

NO

WHAT IS R81?

YES

GO TO Q105

NO/DK/REF

GO TO Q105

1. WHAT IS R87?

2. YES

3. NO

5. GO TO Q105

4. GO TO Q100

100. Do you always inspect your used gloves before applying [RSCREEN4], for all signs of damage and wear, including

small tears, subtle changes in material texture and coloring, and pin holes?

0278

1 Yes – [Go to Q105]

[Go to Q101]

3 No

2 DK

4 REF

5 N/A

101. True or false. It is not necessary to inspect your gloves for all signs of damage and wear each time, before reusing them to apply [RSCREEN4]?

0279

1 True

2 False

3 DK

4 REF

5 N/A

102. [SHOWCARD C5.2]. Please look at this card. [Point to item 1 on the card]

I will read you a list of issues.

Please indicate yes or no for each, if it has ever prevented you from inspecting your gloves properly for all signs of damage and wear, each time, before reusing them to apply [RSCREEN4].

		YES	NO	DK	REF
a.	Thinking you are so careful, that your gloves will never get damaged or worn					0280
b.	Thinking it is better to wear worn or damaged gloves, than no gloves at all					0281
c.	Thinking other growers do not inspect their gloves properly before reusing them					0282
d.	Being too much in a hurry					0283
e.	Being forgetful					0284
f.	Is there any other issue that prevented you from inspecting your gloves properly before reusing them? Specify: 0285 __________________________					0286

0478 N/A

103. [SHOWCARD C5.2] Please look at this card. [Point to item 2 on the card]

I will read you four factors.

Please indicate yes or no for each, if it may cause you to start inspecting your gloves properly for all signs of

damage and wear, each time, before reusing them to apply [RSCREEN4].

		YES	NO	DK	REF
a.	Learning that gloves, with only minor damage or wear, can allow pesticides to get on your skin					0287
b.	Learning that pesticides which get on your skin can potentially harm your health					0288
c.	Learning that the pesticide residues which get on your skin can be transferred to your family					0289
d.	Learning that other growers inspect their gloves properly before reusing them					0290

0479 N/A

104. Is there anything else that might cause you to start inspecting your gloves properly for all signs of damage and wear,

each time, before using them to apply [RSCREEN4]?

0291

1 Y es – Specify: 0292______________________________________________________________________

______________________________________________________________________

3 No

2 DK

4 REF

5 N/A

SECTION C6: RESPIRATORS

105. During your most recent application of [RSCREEN4] [R19], did you wear something to cover your mouth and nose such as a scarf, mask, or respirator?

0293

1 Yes – [Go to Q107]

[Go to Q106]

[Add to Reference (R105_107) & Go to specified question]

3 No

2 DK

4 REF

106. Have you ever worn anything to cover your mouth and nose whenever you have applied [RSCREEN4] [R19] in the past?

0294

1 Yes

[Go to Checkpoint 8a]

3 No

2 DK

4 REF

5 N/A

107. [SHOWCARD C6a] Which one of these images most closely resembles what you wore over your mouth and nose

when you last applied [RSCREEN4] [R19]? (Check one)

0295

1 Piece of cloth, such as a bandanna – [Go to Checkpoint 8a]

[Go to Q108]

[Add to Reference (R105_107) & Go to specified question/item]

2 Filtering facepiece respirator

3 Air-purifying respirator (non-powered)

4 Powered air-purifying respirator (PAPR)

5 Supplied air respirator (SAR)

[Go to Checkpoint 8a]

6 Self-contained breathing apparatus (SCBA)

7 DK

8 REF

9 N/A

108. NIOSH is the National Institute for Occupational Safety and Health. Was your respirator NIOSH approved?

0296

1 Y es

3 No

2 DK

4 REF

5 N/A

109. [SHOWCARD C6b] Please look at this card.

There are two main types of filters, cartridges, and canisters called particulate and organic vapor.

They may be used separately or in combination with each other.

[Point to the images for particulate, organic vapor, and particulate + organic vapor]

Do you know which main type of filter, cartridge, or canister you used, or not?

0297

[Go to Q112]

1 Yes – I KNOW

3 No – I DON’T KNOW

2 REF

4 N/A

110. [SHOWCARD C6b] What was the main type of filter, cartridge, or canister, you used?

[Read each category and point to each on the cards]

0298

1 A particulate – [Go to Q111]

2 An organic vapor – [Go to Q112]

3 A combination of particulate and organic vapor – [Go to Q111]

4 Other – Specify: 0299___________________________________

[Go to Q112]

5 DK

6 REF

7 N/A

111. [SHOWCARD C6b] There are different types of particulate filters. What type did you use?

[Read each category while pointing to each image]

0300

1 An N series

2 An R or P series

3 An HE (high efficiency) or HEPA

4 None of the above

5 DK

6 REF

7 N/A

112. What color were the filters, cartridges, or canisters you used?

[If the respondent specifies more than three, ask:] Which three colors were the most obvious?

Specify: 0301___________________________________

Specify: 0302___________________________________

Specify: 0303___________________________________

0480 DK

0481 REF

0482 N/A

113. Have you always worn the same respirator, or type of respirator, including the filters whenever you have applied

[RSCREEN4] [R19] in the past?

0304

1 Y es

3 No

2 DK

4 REF

5 N/A

114. Did you wear the respirator, in part, to help protect you from breathing in [RSCREEN4]?

0305

1 Y es

3 No

2 DK

4 REF

5 N/A

115. Did anyone advise you to wear this type of respirator and filter for your protection while applying [RSCREEN4]?

0306

1 Y es

3 No

2 DK

4 REF

5 N/A

CHECKPOINT 8a:

WAS THE CORRECT RESPIRATOR/FILTER WORN?

NOTE: IF R17 = NO, DK, OR REF, THEN [CORRECT] = DK

0307

1 Yes

3 No

2 DK

4 N/A

COMPLETE REFERENCE TABLE COLUMN 3 [CORRECT]

CHECKPOINT 8b:

WAS EITHER A FILTERING FACEPIECE RESPIRATOR OR

AN AIR-PURIFYING RESPIRATOR (NON-POWERED) SELECTED IN R105_107?

YES

NO

GO TO Q116

GO TO Q125

116. Prior to using your [R105_107] for your most recent application of [RSCREEN4], did a health care professional ever determine it was safe for you to wear a respirator?

0308

1 Y es

3 No

2 DK

4 REF

5 N/A

117. [If Male:] Have you ever worn your [R105_107], or same type of [R105_107], over a beard?

0309

1 Y es

3 No

2 DK

4 REF

5 N/A – Female respondent

6 N/A

118. Did you personally check whether your [R105_107] sealed tightly to your face with no air leaks before you wore it that last time you applied [RSCREEN4]?

0310

1 Y es

[Go to Q120]

3 No

2 DK

4 REF

5 N/A

119. Did your [R105_107] seal tightly to your face with no air leaks?

0311

1 Y es

3 No

2 DK

4 REF

5 N/A

120. Did someone else ever test to see whether your [R105_107], or same type of [R105_107], fit you properly -- sealing

tightly to your face with no air leaks, even while you made basic movements?

0312

1 Y es – [Go to Q125]

3 No – [Go to Q121]

[Go to Q125]

2 DK

4 REF

5 N/A

121. True of False. Before using your tight-fitting respirator, it is important to be tested by someone else to assure it seals tightly to the face with no air leaks.

0313

1 True

2 False

3 DK

4 REF

5 N/A

122. [SHOWCARD C6.1]. Please look at this card. [Point to item 1 on the card]

I will read you a list of issues

Please indicate yes or no for each, if it prevented you from ever being tested by someone else to see if the type of

respirator you wore fit you properly.

		YES	NO	DK	REF
a.	Thinking it is better to wear a respirator that leaks than to not wear one at all					0314
b.	Thinking other growers are not being tested to see if their respirators fit them properly					0315
c.	Being unsure how to get tested to see if your respirator fits you properly					0316
d.	Is there any other issue that prevented you from being tested to see if the type of respirator you wore fits you properly? Specify: 0317___________________________________________________					0318

0483 N/A

123. [SHOWCARD C6.1. Point to item 2 on the card]

I will read you three factors. Please indicate yes or no for each, if it would cause you to get tested to assure that your

respirator fits you properly before you use it to apply [RSCREEN4]

		YES	NO	DK	REF
a.	Learning that respirators which don’t fit properly, can leak while making only basic movements					0319
b.	Learning that wearing a respirator with, even very small air leaks, can be harmful to your health					0320
c.	Learning that other growers get tested to see if their respirators fit them properly before using them					0321

0484 N/A

124. Is there anything else that might cause you to get tested to see if your respirator fits you properly before using it to apply [RSCREEN4]?

0322

1 Yes – Specify: 0323_______________________________________________________________________

________________________________________________________________________

3 No

2 DK

4 REF

5 N/A

SECTION D: LABEL

These next questions are about pesticide labels.

125. Have you ever read the label for the information on personal protective equipment and clothing to wear from the same product of [RSCREEN4] that you recently applied?

0324

1 Y es – [Go to Q132]

[Go to Q126]

[Add to Reference (R125) & Go to specified question]

3 No

2 DK

4 REF

126. Have you ever read the label for the information on personal protective equipment and clothing to wear from another product of [RSCREEN4] you previously applied?

0325

1 Y es

3 No – I have never read the label for the information from another product of [RSCREEN4] I previously applied

6 No – I have never applied another product of [RSCREEN4]

2 DK

4 REF

5 N/A

127. True or false. A pesticide applicator is required to read every product label for the information on personal protective equipment and clothing to wear before applying it.

0326

1 True

2 False

3 DK

4 REF

5 N/A

128. Are you aware that the pesticide product label information on the personal protective equipment and clothing is updated from time to time?

0327

1 Y es

3 No

2 DK

4 REF

5 N/A

129. [SHOWCARD D] Please look at this card. [Point to item 1 on the card]

I will read you a list of issues. Please indicate yes or no for each, if it prevented you from reading the [RSCREEN4]

product label for the information on the personal protective equipment and clothing to wear.

		YES	NO	DK	REF
a.	The label was always lost or damaged					0328
b.	Thinking the product is safe and requires no special protective equipment or clothing					0329
c.	Thinking you are careful when you apply it, so there is no need to read the label					0330
d.	Thinking you are in too much of a hurry and don’t have time to read the label					0331
d.	Thinking you already know the equipment and clothing needed					0332
e.	Thinking that other growers do not read the label for the information					0333
f.	Thinking the information is too hard to find on the label					0334
g.	Thinking the information is too small to read on the label					0335
h.	Is there any other issue that prevented you from reading the label for this information? Specify: 0336___________________________________________________					0337

0485 N/A

130. [SHOWCARD D. Point to item 2 on the card]

I will read you a list of five factors.

Please indicate yes or no for each, if it might cause you to read the [RSCREEN4] product label for the personal protective equipment and clothing to wear before applying it again.

		YES	NO	DK	REF
a.	Learning that wearing personal protective equipment and clothing which is less protective than required by label can allow you to be exposed to a pesticide					0338
b.	Learning that pesticides can get on you even when you are careful while applying them					0339
c.	Learning that you can transfer pesticide residues on you to your family					0340
d.	Learning that other growers always read pesticide product labels before applying them					0341
e.	Learning you could be cited for wearing personal protective equipment and clothing which is less protective than required by label					0342

0486 N/A

131. Is there anything else that might cause you to read the [RSCREEN4] product label before applying it again?

0343

1 Y es – Specify: 0344___________________________________________________________

[Go to

Checkpoint 9]

___________________________________________________________

3 No

2 DK

4 REF

5 N/A

132. Were you able to find information on the product label about which personal protective equipment and clothing should

be worn?

0345

1 Y es

[Add to Reference (R132) & Go to Checkpoint 9]

3 No

2 DK

4 REF

5 N/A

CHECKPOINT 9:

WERE BOTH R125 AND R132 = YES

YES

NO

GO TO CHECKPOINT 10

GO TO Q175

SECTION E1: HEADWEAR

CHECKPOINT 10:

WAS THE CORRECT HEADWEAR WORN?

NO

YES/DK/NA

GO TO Q133

GO TO CHECKPOINT 11

The next questions are about the label requirement for [HEADWEAR] when you last applied [RSCREEN4] [R19].

133. When you read the pesticide label, did you understand the requirement for [HEADWEAR] which includes [HFEATURES]?

0346

1 Y es – [Go to Q135]

3 No – [Go to Q134]

[Go to Q135]

2 DK

4 REF

134. What about the requirement made it difficult to understand?

Specify: 0347________________________________________________________________________

0487 DK

0488 REF

0489 N/A

135. Did you have any proper [HEADWEAR] when you last applied [RSCREEN4] [R19]?

0348

1 Y es

3 No

2 DK

4 REF

5 N/A

136. Were you aware of any place that sold proper [HEADWEAR]?

0349

1 Y es

3 No

2 DK

4 REF

5 N/A

137. [SHOWCARD E] Please look at this card. [Point to item 1 on the card]

I will read a list of issues.

Please indicate yes or no for each issue, if it prevented you from wearing proper [HEADWEAR] the last time you

applied [RSCREEN4].

		YES	NO	DK	REF
a.	Label requirements that are unclear					0350
b.	Thinking you don’t know where to buy it					0351
c.	Thinking you are so careful that pesticides won’t get on your head					0352
d.	Thinking it interferes with your ability to work safely					0353
e.	Thinking it interferes with your ability to work quickly					0354
f.	Thinking other growers do not wear it					0355
g.	Thinking it is too hot to wear					0356
h.	Thinking it tears too easily					0357
i.	Thinking it is too uncomfortable (other than being hot)					0358
j.	Is there any other issue that prevented you from wearing proper [HEADWEAR] the last time you applied [RSCREEN4]? Specify: 0359______________________________________					0360

0490 N/A

138. [SHOWCARD E. Point to item 2 on the card] I will read you three factors.

Please indicate yes or no for each factor, if it might cause you to wear proper [HEADWEAR] every time you apply

[RSCREEN4].

		YES	NO	DK	REF
a.	Learning that pesticides can get on you even if you are careful while applying them					0361
b.	Learning the pesticides residues that get in your hair and on your head can be transferred to your family					0362
c.	Learning that other growers are wearing it					0363

0491 N/A

139. Is there anything else that might cause you to wear proper [HEADWEAR] every time you apply [RSCREEN4]?

0364

1 Y es – Specify: 0365______________________________________________________________________

______________________________________________________________________

3 No

2 DK

4 REF

5 N/A

SECTION E2: EYEWEAR

CHECKPOINT 11:

WAS THE CORRECT EYEWEAR WORN?

NO

YES/DK/NA

GO TO Q140

GO TO CHECKPOINT 12

The next questions are about the label requirement for [EYEWEAR] when you last applied [RSCREEN4] [R19].

140. When you read the pesticide label, did you understand the requirement for [EYEWEAR] which includes [EFEATURES]?

0366

1 Y es – [Go to Q142]

3 No – [Go to Q141]

[Go to Q142]

2 DK

4 REF

141. What about the requirement made it difficult to understand?

Specify: 0367________________________________________________________________________

0492 DK

0493 REF

0494 N/A

142. Did you have any proper [EYEWEAR] when you last applied [RSCREEN4] [R19]?

0368

1 Y es

3 No

2 DK

4 REF

5 N/A

143. Were you aware of any place that sold proper [EYEWEAR]?

0369

1 Y es

3 No

2 DK

4 REF

5 N/A

144. [SHOWCARD E] Please look at this card. [Point to item 1 on the card]

I will read a list of issues.

Please indicate yes or no for each issue, if it prevented you from wearing proper [EYEWEAR] the last time you

applied [RSCREEN4].

		YES	NO	DK	REF
a.	Label requirements that are unclear					0370
b.	Thinking you don’t know where to buy it					0371
c.	Thinking you are so careful that pesticides won’t get in your eyes					0372
d.	Thinking it interferes with your ability to work safely					0373
e.	Thinking it interferes with your ability to work quickly					0374
f.	Thinking other growers do not wear it					0375
g.	Thinking it is too hot to wear					0376
h.	Thinking it gets too dirty					0377
i.	Thinking it is too uncomfortable (other than being hot)					0378
j.	Is there any other issue that prevented you from wearing proper [EYEWEAR] the last time you applied [RSCREEN4]? Specify: 0379______________________________________					0380

0495 N/A

145. [SHOWCARD E. Point to item 2 on the card]

I will read you two factors.

Please indicate yes or no for each factor, if it might cause you to wear proper [EYEWEAR] every time you apply

[RSCREEN4].

		YES	NO	DK	REF
a.	Learning that pesticides can get on you even if you are careful while applying them					0381
b.	Learning that other growers are wearing it					0382

0496 N/A

146. Is there anything else that might cause you to wear proper [EYEWEAR] every time you apply [RSCREEN4]?

0383

1 Y es – Specify: 0384______________________________________________________________________

______________________________________________________________________

3 No

2 DK

4 REF

5 N/A

SECTION E3: CLOTHING

CHECKPOINT 12:

WAS THE CORRECT CLOTHING WORN?

NO

YES/DK/NA

GO TO Q147

GO TO CHECKPOINT 13

The next questions are about the label requirement for [CLOTHING] when you last applied [RSCREEN4] [R19].

147. When you read the pesticide label, did you understand the requirement for [CLOTHING] which includes [CFEATURES]?

0385

1 Y es – [Go to Q149]

3 No – [Go to Q148]

[Go to Q149]

2 DK

4 REF

148. What about the requirement made it difficult to understand?

Specify: 0386________________________________________________________________________

0497 DK

0498 REF

0499 N/A

149. Did you have any proper [CLOTHING] when you last applied [RSCREEN4] [R19]?

0387

1 Y es

3 No

2 DK

4 REF

5 N/A

150. Were you aware of any place that sold proper [CLOTHING]?

0388

1 Y es

3 No

2 DK

4 REF

5 N/A

151. [SHOWCARD E] Please look at this card. [Point to item 1 on the card]

I will read a list of issues.

Please indicate yes or no for each issue, if it prevented you from wearing proper [CLOTHING] the last time you

applied [RSCREEN4].

		YES	NO	DK	REF
a.	Label requirements that are unclear					0389
b.	Thinking you don’t know where to buy it					0390
c.	Thinking you are so careful that pesticides won’t get on you					0391
d.	Thinking they interfere with your ability to work safely					0392
e.	Thinking they interfere with your ability to work quickly					0393
f.	Thinking other growers do not wear them					0394
g.	Thinking you are not able to get them in your size					0395
h.	Thinking they are too hot to wear					0396
i.	Thinking they tear too easily					0397
j.	Thinking they are too uncomfortable (other than being hot)					0398
k.	Is there any other issue that prevented you from wearing them the last time you applied [RSCREEN4]? Specify: 0399______________________________________					0400

0500 N/A

152. [SHOWCARD E. Point to item 2 on the card]

I will read you three factors.

Please indicate yes or no for each factor, if it might cause you to wear proper [CLOTHING] every time you apply

[RSCREEN4].

		YES	NO	DK	REF
a.	Learning that pesticides can get on you even if you are careful while applying them					0401
b.	Learning the pesticides residues that get in your hair and on your head can be transferred to your family					0402
c.	Learning that other growers are wearing them					0403

0501 N/A

153. Is there anything else that might cause you to wear proper [CLOTHING] every time you apply [RSCREEN4]?

0404

1 Y es – Specify: 0405______________________________________________________________________

______________________________________________________________________

3 No

2 DK

4 REF

5 N/A

SECTION E4: FOOTWEAR

CHECKPOINT 13:

WAS THE CORRECT FOOTWEAR WORN?

NO

YES/DK/NA

GO TO Q154

GO TO CHECKPOINT 14

The next questions are about the label requirement for [FOOTWEAR] when you last applied [RSCREEN4] [R19].

154. When you read the pesticide label, did you understand the requirement for [FOOTWEAR] which includes [FFEATURES]?

0406

1 Y es – [Go to Q156]

3 No – [Go to Q155]

[Go to Q156]

2 DK

4 REF

155. What about the requirement made it difficult to understand?

Specify: 0407________________________________________________________________________

0502 DK

0503 REF

0504 N/A

156. Did you have any proper [FOOTWEAR] when you last applied [RSCREEN4] [R19]?

0408

1 Y es

3 No

2 DK

4 REF

5 N/A

157. Were you aware of any place that sold proper [FOOTWEAR]?

0409

1 Y es

3 No

2 DK

4 REF

5 N/A

158. [SHOWCARD E] Please look at this card. [Point to item 1 on the card]

I will read a list of issues.

Please indicate yes or no for each issue, if it prevented you from wearing proper [FOOTWEAR] the last time you

applied [RSCREEN4].

		YES	NO	DK	REF
a.	Label requirements that are unclear					0410
b.	Thinking you don’t know where to buy it					0411
c.	Thinking you are so careful that pesticides won’t get on your feet					0412
d.	Thinking they interfere with your ability to work safely					0413
e.	Thinking they interfere with your ability to work quickly					0414
f.	Thinking other growers do not wear them					0415
g.	Thinking you are not able to get them in your size					0416
h.	Thinking they are too hot to wear					0417
i.	Thinking they tear too easily					0418
j.	Thinking they are too uncomfortable (other than being hot)					0419
k.	Is there any other issue that prevented you from wearing them the last time you applied [RSCREEN4]? Specify: 0420______________________________________					0421

0505 N/A

159. [SHOWCARD E. Point to item 2 on the card]

I will read you three factors.

Please indicate yes or no for each factor, if it might cause you to wear proper [FOOTWEAR] every time you apply

[RSCREEN4].

		YES	NO	DK	REF
a.	Learning that pesticides can get on you even if you are careful while applying them					0422
b.	Learning the pesticides residues that get in your hair and on your head can be transferred to your family					0423
c.	Learning that other growers are wearing them					0424

0506 N/A

160. Is there anything else that might cause you to wear proper [FOOTWEAR] every time you apply [RSCREEN4]?

0425

1 Y es – Specify: 0507______________________________________________________________________

______________________________________________________________________

3 No

2 DK

4 REF

5 N/A

SECTION E5: GLOVES

CHECKPOINT 14:

WERE EITHER THE CORRECT OUTER OR CORRECT INNER GLOVES WORN?

NO

YES/DK/NA

GO TO Q161

GO TO CHECKPOINT 15

The next questions are about the label requirement for [GLOVES] when you last applied [RSCREEN4] [R19].

161. When you read the pesticide label, did you understand the requirement for [GLOVES] which includes [GFEATURES]?

0426

1 Y es – [Go to Q163]

3 No – [Go to Q162]

[Go to Q163]

2 DK

4 REF

162. What about the requirement made it difficult to understand?

Specify: 0427________________________________________________________________________

0508 DK

0509 REF

0510 N/A

163. Did you have any proper [GLOVES] when you last applied [RSCREEN4] [R19]?

0428

1 Y es

3 No

2 DK

4 REF

5 N/A

164. Were you aware of any place that sold proper [GLOVES]?

0429

1 Y es

3 No

2 DK

4 REF

5 N/A

165. [SHOWCARD E]. Please look at this card. [Point to item 1 on the card].

I will read a list of issues.

Please indicate yes or no for each issue, if it prevented you from wearing proper [GLOVES] the last time you

applied [RSCREEN4].

		YES	NO	DK	REF
a.	Label requirements that are unclear					0430
b.	Thinking you don’t know where to buy it					0431
c.	Thinking you are so careful that pesticides won’t get on your hands					0432
d.	Thinking they interfere with your ability to work quickly					0433
e.	Thinking other growers do not wear them					0434
f.	Thinking you are not able to get them in your size					0435
g.	Thinking they are too hot to wear					0436
h.	Thinking they tear too easily					0437
i.	Thinking they are too uncomfortable (other than being hot)					0438
j.	Is there any other issue that prevented you from wearing them the last time you applied [RSCREEN4]? Specify: 0439______________________________________					0440

0511 N/A

166. [SHOWCARD E. Point to item 2 on the card]

I will read you three factors.

Please indicate yes or no for each factor, if it might cause you to wear proper [GLOVES] every time you apply

[RSCREEN4].

		YES	NO	DK	REF
a.	Learning that pesticides can get on you even if you are careful while applying them					0441
b.	Learning the pesticides residues that get in your hair and on your head can be transferred to your family					0442
c.	Learning that other growers are wearing them					0443

0512 N/A

167. Is there anything else that might cause you to wear proper [GLOVES] every time you apply [RSCREEN4]?

0444

1 Y es – Specify: 0445______________________________________________________________________

______________________________________________________________________

3 No

2 DK

4 REF

5 N/A

SECTION E6: RESPIRATORY PROTECTION

CHECKPOINT 15:

WERE THE CORRECT RESPIRATORS/FILTERS WORN?

NO

YES/DK/NA

GO TO Q168

GO TO Q175

The next questions are about the label requirement for [RESPIRATOR/FILTER] when you last applied [RSCREEN4] [R19].

168. When you read the pesticide label, did you understand the requirement for [RESPIRATOR/FILTER] which includes [RFEATURES]?

0446

1 Y es – [Go to Q170]

3 No – [Go to Q169]

[Go to Q170]

2 DK

4 REF

169. What about the requirement made it difficult to understand?

Specify: 0447________________________________________________________________________

0513 DK

0514 REF

0515 N/A

170. Did you have any proper [RESPIRATOR/FILTER] when you last applied [RSCREEN4] [R19]?

0448

1 Y es

3 No

2 DK

4 REF

5 N/A

171. Were you aware of any place that sold proper [RESPIRATOR/FILTER]?

0449

1 Y es

3 No

2 DK

4 REF

5 N/A

172. [SHOWCARD E] Please look at this card. [Point to item 1 on the card]

I will read a list of issues.

Please indicate yes or no for each issue, if it prevented you from wearing proper [RESPIRATOR/FILTER] the last time

you applied [RSCREEN4].

		YES	NO	DK	REF
a.	Label requirements that are unclear					0450
b.	Thinking you don’t know where to buy it					0451
c.	Thinking it is too easily damaged					0452
d.	Thinking you are so careful that you won’t breathe in pesticides					0453
e.	Thinking it interferes with your ability to work quickly					0454
f.	Thinking other growers do not wear it					0455
g.	Thinking it is too expensive					0456
h.	Thinking it is too hot to wear					0457
i.	Thinking they are too uncomfortable (other than being hot)					0458
j.	Is there any other issue that prevented you from wearing proper [RESPIRATOR/FILTER] the last time you applied [RSCREEN4]? Specify: 0459______________________________________					0460

0516 N/A

173. [SHOWCARD E. Point to item 2 on the card]

I will read you two factors.

Please indicate yes or no for each factor, if it might cause you to wear proper [RESPIRATOR/FILTER] every time you

apply [RSCREEN4].

		YES	NO	DK	REF
a.	Learning that you can breathe pesticides in even when you’re careful					0461
b.	Learning that other growers are wearing them					0462

0517 N/A

174. Is there anything else that might cause you to wear proper [RESPIRATOR/FILTER] every time you apply [RSCREEN4]?

0463

1 Y es – Specify: 0464______________________________________________________________________

______________________________________________________________________

3 No

2 DK

4 REF

5 N/A

175. Thank you very much for your time. That is all the questions I have for you today.

Comments:

That completes our survey. Thank you for your help

We may need additional information later in 2014 to complete this study. If so, we will contact you in November or December to set up a time that is good for you.

	Respondent Name:	9911 Phone:	9910 MM DD YY Date:

For questions or concerns, please contact __________________ at ____________________.

Response		Respondent		Mode		Enum.	Eval.	R. Unit	Change	Office Use for POID
1-Comp 2-R 3-Inac 4-Office Hold 5-R – Est 6-Inac – Est 7-Off Hold – Est 8-Known Zero	9901	1-Op/Mgr 2-Sp 3-Acct/Bkpr 4-Partner 9-Oth	9902	1-Mail 2-Tel 3-Face-to-Face 4-CATI 5-Web 6-e-mail 7-Fax 8-CAPI 19-Other	9903	098	100	921	785	789 __ __ __ - __ __ __ - __ __ __
										Optional Use
										407	408		9906	9916
S/E Name

Office Use Only